Podcasts about icd9

Dr. Deb Muth 0:03There’s a quiet shift happening in healthcare right now, and most doctors aren’t talking about it yet. People aren’t chasing diagnoses anymore. They’re exhausted by them. I see it every single day in my clinic. People who come in with stacks of paperwork, portals full of results, and a list of diagnoses longer than their grocery receipt, yet they’re still not living their lives. And they’ll say to me, Dr. Deb, I don’t want another label. Dr. Deb Muth 0:32 I just want my life back. If you’ve ever been told this is just how your body is, if you’ve been diagnosed, rediagnosed, and then dismissed, if you’ve been handed labels but never handed a roadmap, today’s episode is for you. Because we are officially entering what I call the post diagnosis era and it’s changing everything about how healing actually happens. So grab your cup of coffee or tea and let’s settle in to let’s talk wellness. Now, before we dive in, we need to take a quick pause to thank today’s sponsor. And when we come back, we’re going to talk about why diagnoses are no longer the most important thing about you. Dr. Deb Muth 1:17Did you know sweating can literally heal your cells? And infrared saunas don’t just relax you, they detox your body, balance hormones, and boost mitochondrial energy. I’m obsessed with my health tech sauna, and right now you can save $500 with my code at healthtechhealth.com Dr. Muth req 25 so here’s some truth for me. Dr. Deb Muth 0:47It was three years ago Christmas that I received my Ms. Diagnosis. And I remember it very clearly. It was the day before, two days before Christmas Eve, that I got the call and I heard the words, you have white matter brain disease. That’s consistent with Ms. And I immediately stopped in my tracks and thought, okay, well, this is just the way it is. We’re gonna fight this. We’re gonna figure this out. And it led me down a deeper path of healing and spirituality and emotional growth. And there were some really difficult days ahead for me because I remember thinking, what am I gonna do? How am I gonna practice what’s going to happen in my life? And every year at this time, I reflect back to that day that I got the call that really changed my life. And not for the worse, but for the better. It changed the way I was thinking about life. Dr. Deb Muth 3:01It changed the way I was complaining about things being ungrateful for all the amazing things that I have in my life. Not intentionally, but just living the American life. Right. Dr. Deb Muth 3:14And striving for more and wanting more and chasing more and doing more, and never really having the opportunity to just be present and just really think about life and enjoy what the Lord has given us and enjoy what’s around me, the people in my life, the family that I have, the amazing practice that I have, and the amazing people I get to work with and change lives with. And it really changed me for the better. And I’ve watched diagnoses like this change people for the worse and for them to sink deep into a depression and give up and. And live to their label instead of living to their potential. And that’s why I think this episode is so important for us, because we all have a choice in life. When we get dealt something kind of difficult, we can let it consume us and let it take every ounce of life from us, or we can allow it to become the fuel that makes us better, makes us contribute to life maybe differently, but in a better way. So, you know, I know that this idea of letting diagnoses lose their power can be really uncomfortable for some people, because there’s people that are waiting for that diagnosis. I’m in some. Some social media groups, and I’m listening and reading to people who are saying, I’m so angry I didn’t get the Ms. Diagnosis today. I’m so angry I didn’t get the Lyme diagnosis today. I’m so upset that they can’t find anything wrong with me. And I understand. Dr. Deb Muth 5:20I know the feeling of wanting to put a name to what you’re feeling so that you have validation and you have power around this diagnosis, and you can prove to people that what you’re feeling is not in your head. I get all of that. But for many people, the original diagnosis is meant to help guide treatment in the conventional sense. It’s a created, shared language that we have, and it brings clarity. But for many people, you give that label and that name so much power and so much control over your life and who you are and what you’re being. And that’s not what the label is meant for. Somewhere along the line, medicine started confusing naming with healing. And today, we have more diagnoses than ever. We have more testing than ever. We have so many thousands of specialists, and yet people are sicker. They’re more inflamed, they’re more exhausted, they’re more confused than ever. And that’s not just a coincidence. That is how the system is meant to work. It’s meant to confuse you. Dr. Deb Muth 6:44It’s meant to keep you dependent on it. It’s meant to. Meant to keep you on medical management for the rest of your life. And by doing that, we enrich the pharmaceutical companies to the point where their whole role is to continue to create drugs that you need to be on for the rest of your life. And the hard truth about all of this that I’ve seen in my practice is for many patients, the diagnosis really becomes their identity. They own it, they gravitate to it. It’s who they are. It also becomes their prison because they only live confined inside the diagnosis. I can’t do this because I can’t do that, because if I do this, this will happen, because I have. They’ve capped their ceiling of life based on a couple of words that somebody gave them at a point in their life when they were so low and potentially so desperate that they needed that name to identify themselves and what was going on. And instead of asking, why is this happening? Dr. Deb Muth 8:05Why are these symptoms happening? What’s causing these symptoms? They’re told, this is what you have, and this is what you’re going to have to live with. And instead of restoring function, these people become managed. Like I said, they’re managed with drugs. They’re managed inside the system. And instead of healing, they’re monitored with this blood test and that blood test and this MRI and that mri. Instead of providing hope, they’re handed a lifelong prescription with expectations that do nothing but decline. So you walk out of that room with this expectation that your life is never going to be the same, that your function is going to decline, your neurological disease is going to take over eventually, you’re going to be put in a home, you’re going to lose everything you have because you’re not going to be able to afford the care that you need. And that’s the expectations of our healthcare system today. When you’re labeled with a chronic illness diagnosis, and for a woman, especially women, this is magnified because their symptoms are told to them as. It’s stress, it’s hormones, it’s anxiety, it’s aging, it’s motherhood, and then, of course, it’s perimenopause. Like that is some major traumatic thing that should disrupt your entire life. Yet it shouldn’t, and it does, and it doesn’t have to. And of course, my favorite is always, but your labs are normal. We don’t know what’s wrong with you. It must just be in your head. Dr. Deb Muth 9:53And this is why women are done being dismissed, why this shift is happening now that we are empowering women to take back Their lives, take back who they are and take back how they’re being treated in the healthcare system. And it is one of the most important things that we can do right now is to give women their power back so that they can stand strong in who they are and in their intuition and fight and say, no, this is not happening to me right now. I am not accepting this label. I’m not accepting this diagnosis. I will fight, I will find answers, and I will do what I need to do to be the woman that I want to be. So why is this conversation exploding right now? Well, there’s actually three big reasons, and first and foremost, it’s over. Diagnosis, burnout. People are collecting diagnoses without solutions. Autoimmune labels, syndromes, vague neurological names, but no one’s connecting the dots. Dr. Deb Muth 11:02You see, when you start to stack these labels on top of each other, one after the next after the next, you know, it’s celiac disease, it’s Hashimoto’s, it’s fibromyalgia, it’s autoimmune. You know, rheumatoid arthritis. It’s. Whatever it is, it’s long haul Covid. These days, no one is putting these connections together to say, why are you developing so many diseases that are so similar in nature, ones that just kind of domino after each other? Nobody’s looking at your immune system. Nobody’s measuring it, Nobody’s telling you how well it’s working. No one’s supporting it. They’re just throwing these biological drugs at you. And if there’s an autoimmune disease and sending you on your way and saying, this is what you have to look forward to for the rest of your life. But don’t worry, these side effects are rare, including cancer. It does not make sense to me that we are not looking at the root cause for all of these crazy diagnoses that we are labeling people with today. And I am guilty of it myself, because within the system that we work, we have to label something in order for you to receive the care that you need, for your insurance, to pay for the treatment, for the tests, for the visits. There has to be a label. And that’s what we call an ICD10 code. And if we don’t have the appropriate label, none of what we’re recommending gets covered for you. And that’s the label game began. The second thing is long haul Covid. And post viral illnesses. Dr. Deb Muth 12:47Millions of people were told, we don’t know why, and then we sent them home to figure it out by themselves. We don’t know why your immune system is failing, we don’t know why you’re having these clotting issues that are happening. But don’t worry, these clotting issues really are not that severe. They’re mild in nature. You’ll never have to worry about it. And we’re not going to treat it even though it’s four times the level that’s normal, because we’re going to wait until it’s 10 times the level of normal to even worry about it at this point. Dr. Deb Muth 13:19And it will take us 25 to 30 years before we understand any of the risks and barriers that have happened from these post viral illnesses that have occurred in our environment and the ones that are in the future to come. Because it takes time for us to study things, it takes time for us to figure it out, takes time for us to train the practitioners, and it takes time for us to accept something different than we thought was reality. And that is the problem that we have today with these post viral illnesses that are long acting, that are retriggering new viruses, retriggering old illnesses like Lyme, reactivating things like Epstein Barr virus. It will take decades before this becomes mainstream. And right now it’s fringe medicine and it’s not realistic. And those of us that are speaking about it are chastised and gone after, but by our medical communities and we are told that we are the crazy ones. And that is how medicine has always been. Way in the beginning, and I forget the doctor’s name, who started just observing that when medical students worked on cadavers and then came into the labor and delivery ward and delivered babies, these women were getting sick with infections and they were dying. And he said, what if we just washed our hands between the cadaver and the delivery? Would we save lives? And he did a small study and he was right. And over time he was made fun of and he was put into insane asylums and he was locked away. And now today we would never think of entering a room and working on a patient without washing our hands beforehand. But that took 30 years for that one concept of washing hands to be adopted. And it destroyed one man’s life because he simply asked the question, what if it’s a crazy society that we live in, It’s a crazy outlook that we have on medicine and asking questions. And sometimes I wonder, is it truly science or is it politically driven? And I think the answer is it’s both. And the third thing that we have is technology. And technology is outpacing wisdom by far. Hands down, AI, advanced labs and imaging can identify everything. Now using AI, but without context, it creates a fear. Dr. Deb Muth 16:08And instead of clarity, without context, using AI to interpret labs makes absolutely no sense. Without context and understanding and us actually training this LLM model, the AI doesn’t really know what it, what it means. And someday it will, I’m sure, but right now it doesn’t. So as everyone is taking to AI to treat themselves and create a protocol and diagnose themselves and understand their labs and know that it is without context that you are doing this, and research is wonderful, but without having somebody truly understand you and the art of healing and the art of medicine, this is going to get lost and you will not have the information that you truly need simply by using chat GPT. Now I’ve created my own version called Venari and I hope that this will be much better because it will have context. It will have 15,000 protocols that I have used for the last 25 years. It will have lots of research. It has all of the research databases that we can connect to. It has training that I have given it using my brain and how I see a client every single day in practice. So when you’re using our Venari app, you will be able to have that context. You will be able to have that pushback and that voice. And not only that, you will have the option then to work alongside someone to help you identify that context that you’re looking for. Does this make sense? Dr. Deb Muth 17:53I’ve seen this a lot in the peptide world, where in these Facebook groups, people are talking about the peptide stacks that they’re using and they’re telling people that it’s okay to use any peptide you want because they’re just small chain branch amino acids. And that can’t be farther from the truth because there are some peptides you would not want to use because they can stimulate the growth of cells. And if you have cancer or if you have a history of this, there are some peptides that we need to avoid. And unfortunately, AI doesn’t understand that yet and doesn’t know that yet. And it’s just creating stacks. And people are creating stacks without understanding what they’re doing. And I watched my best friend do this as she was learning peptides and she had cancer and it created an aggressive sarcoma. And I believe the peptides had a lot to do with that because it stimulated the growth of the cells. And it wasn’t until after she had passed away that we found this journal of hers that she was studying peptides and recognized that this could have contributed to her advanced cancer. And if you don’t have that context and you’re using AI to create these stacks for you, you can put yourself in harm’s way. And so AI technology, I think, is going to be fantastic in a lot of ways. It’s going to have its downfalls. And you’re going to need an expert when you’re using AI. You’re not going to just be able to treat yourself with this. You know, understanding that more data doesn’t always equal healing, and more data can be helpful. But again, you have to understand how to put those pieces together, how to ask the right question questions. And for that, you need somebody who has seen thousands and thousands of cases to find the missing pieces for you. Because AI is not going to do that unless it’s been trained to do that. Vanari has been trained to do that. Dr. Deb Muth 20:01It’s been trained to push back and look at lime and mold and toxins and chemicals and metals and all of those things. But there is no other AI bot out there, LLM that has been trained to do that using clinical data that I use every single day in my practice. And people are finally realizing that, you know, they’re understanding that although this world of AI and technology is amazing, it has its limitations, just like practitioners have their limitations. We don’t know everything. We are not perfect. We are human. And humans make errors and we miss things. With or without technology, we miss things. And part of it is because we just don’t know what we don’t know yet. And sometimes it’s because we have our blinders on, and sometimes it’s just simply because we don’t have the information today that we’re going to have five years from now. And here’s what I teach instead. I teach the seenet last. And that’s what we built it on. Restore and root. Rise and restore. Sorry, that is my methodology. And it’s in the scene at last book. And it starts with healing. It starts with asking better questions. So instead of asking, what do you have? We want to ask, what has your body been exposed to? What symptoms are underperforming? What’s driving the inflammation for you? When you have joint pain and you have muscle pain and you have achiness, that is not normal. Dr. Deb Muth 21:38I don’t care if you’re 20 or you’re 80, it is not normal. And yes, I did say 80, because we are not supposed to have that kind of inflammation at 80. And why are we underperforming? Why is our Brain not working correctly? Why is our mood not working? Why can’t my body push up a hill? Why can’t I lift 10 pounds? What’s going on? Why can’t I recover from that activity? What’s interfering with my ability to repair and heal after I’ve done some things that I need to do? What’s keeping your nervous system stuck in this survival mode, in this fight or flight mode? Why can’t I get past that? Sometimes that answer is really simple and sometimes that answer, it is so hard and so complicated and it is so many things that are causing this body to be stuck. And sometimes it’s a six month fix, and sometimes it’s a six year fix and sometimes it’s decades long. And it is one of the most challenging things as a practitioner to get clients to understand and to be on the other side of the table and not get you that quick fix. It is extremely difficult for us as well when we are not seeing the results that we think we should see. We need to focus on function over diagnosis, root cause over labels. Dr. Deb Muth 23:09What is driving all this inflammation and certainly restoration over resignation. Do not resign to the fact that you have this life altering disease that is never going to change. Because if we find the root and we restore the body, you don’t have to live in that death sentence that you’ve been given of a diagnosis, whether it’s fibromyalgia, MS, Alzheimer’s disease, celiac disease, Hashimoto’s thyroiditis, it does not matter what that diagnosis is. We can change it, we can make it better, we can reduce the symptoms, we can improve your life. Maybe not in ways that you are absolutely looking for, maybe not in a perfect world, but we can change the trajectory of where your life is going. And it’s because you’re not an ICD9 code or an ICD10 code. You’re not a code, you’re not an MRI result, you’re not a lab result, you’re a human body asking support, not a name. And I say that with a little hesitation because so many people are looking for the name. So many people are angry that someone didn’t find the name. I have clients that come to me that are so angry that the conventional medicine system did not identify their Lyme disease, that they’re looking for someone to sue and there is no one to sue because they didn’t find it, because sometimes they just don’t know. You’re asking for conventional medicine, practitioner and system to provide for you a label that is not within their wheelhouse to do. Because the way they treat Lyme disease and the way an eyelads practitioner looks at Lyme disease and has. Has the ability to test differently are two very different things. Dr. Deb Muth 25:27You’re asking for a system to perform in a way that they are not trained and guided to do. Then you’re looking and asking for somebody to place blame for an illness that you have, that you have yet taken ownership for. And I know that sounds harsh, and I know there’s going to be a lot of people that are angry at me for saying that. But I sit in front of you as someone who had Lyme disease, who had mold mycotoxin illness, who had high viral titers, who had post Covid peripheral neuropathy, who had the diagnosis of ms, who has white matter brain disease, who treated all of it not in the conventional world, who has halted the white matter disease and regrew her brain by 1.5 standard deviations, which is unheard of in 18 months. So I can say this to you. There is no one to blame for your lack of diagnosis or your diagnosis. It is life. It is what happens to us. And you have a choice at the crossroad to either take the path of hatred and anger and bitterness and blame and never getting better a result of that, or you have the ability to take the path of curiosity and openness and willingness to change and willingness to walk down a path that is different than what the conventional medicine is telling you to do. And those are your choices and you get to make those choices. But what you don’t get to do is blame some someone else and try to destroy them for something that they are not able to do. That is not what we get to do in this life. Dr. Deb Muth 27:29It is not right and it is not fair. If someone has truly injured you, that’s different. That’s different. But this looking to blame somebody because they didn’t give you a label, Ridiculous in my opinion. And if you’re listening and thinking right now, I’ve been diagnosed, but I’m not better, I want you to hear this clearly. You are not broken. You are not crazy, and you are not done. Sometimes the most healing moment isn’t getting that diagnosis. It’s realizing that the diagnosis was never the whole story. And that’s where the real healing begins. When we look at the entire story, we look at your entire life from the beginning to where you are now and what has happened to get you there. And once we get that, then we can put you back together. Not in the old way, in a new way in an amazing way, in a way that you would cherish your life for every moment that you have of it. Good, bad and ugly. A diagnosis should not be the doorway. It’s not a dead end. It is just the beginning. Remember, you don’t need another diagnosis. You need your life back. And that’s what’s important. Dr. Deb Muth 29:19We are living in a moment where medicine is being forced to evolve not because systems want to, but because patients are demanding better. This post diagnosis era isn’t about rejecting science, it’s about using it wisely. It’s about restoring function, dignity and hope. And I hope that if this episode resonated with you, share it with someone who’s been labeled but not yet helped. Because sometimes the most powerful healing starts when someone finally feels seen. Thank you for being with me here today. If you haven’t already, make sure you subscribe and follow. Let’s talk Wellness now on YouTube, Spotify or wherever you’re listening and I’ll see you next time. Until then, keep asking better questions, trusting your body and remembering you are more than a diagnosis.The post Episode 254 – Beyond the Diagnosis: Healing in a Post-Diagnosis Era first appeared on Let's Talk Wellness Now.

Als Tinnitus wird ein durchgehender Pfeifton bezeichnet der oft als äußerst unangenehm empfunden wird.

In this episode, Dr’s J and Santhosh continue their tale of the cast of characters who created modern residencies. Along the way, they cover drug addiction, William Osler, facial hair, medical pranks, penis captivus, alliterative teaching, harry potter houses, house officers, the creation of chief residents, ICD9 codes, the diagnostic elevator pitch, the hidden role of women in medical school and more! So Sit back, relax, and learn the history of how doctors get trainedSupport Us spiritually, emotionally or financially here! Twitter: @doctorjcomedy @toshyfro Instagram: @travelmedicinepodcast Spotify: https://open.spotify.com/show/28uQe3cYGrTLhP6X0zyEhTFacebook: facebook.com/travelmedicinepodcast Squarespace: travelmedicinepodcast.squarespace.com Patreon: https://www.patreon.com/travelmedicinepodcast Gmail: travelmedicineinfo@gmail.com

Gail Smith speaks with host Dan Kelly about the latest edition of her book Basic CPT and HCPCS Coding, a textbook she's overseen for the past 25 years. Gail shares multiple observations and stories about what it takes to create and perfect an AHIMA publication! The book is available at https://my.ahima.org/store/product?id=65593.

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Doctor Carolyn Lam, associate editor for the National Heart Center and Duke National University of Singapore. Our feature paper today presents the first information on the impact of cardiovascular health in middle age and the burden of mobility in older age. This exciting data is from the Chicago Heart Association study. First, let me give you your summary of this week's journal.                                                 The first study tells us that patients with long QT syndrome type II are at increased risk of hypoglycemia. First author, Doctor Hilton Cavallius, co-corresponding authors Doctor Tarakov and Hanson from University of Copenhagen, Denmark, noticed that loss of function mutations in HERG, which encodes the voltage gate at potassium channel 11.1, causes long QT syndrome II, but that the specific voltage gate at potassium channels are also present in pancreatic alpha and beta cells and intestinal L and K cells, which secrete glucagon, insulin, and the incretins, glucagon-like peptide one or GLP1, and glucose-dependent insulinotropic polypeptide, or GIP.                                                 All these hormones are crucial for glucose regulation. The authors therefore hypothesize that patients with long QT syndrome II may have increased incretin and beta cell, but decreased alpha cell function and thus, lower glucose levels. To test this hypothesis, they measured secretion of these hormones and cardiac repolarization in response to a six-hour, 75 gram oral glucose tolerance test in 11 patients with long QT syndrome II with functional mutations in HERG with 22 matched healthy participants.                                                 They found that following glucose ingestion, patients with long QT syndrome II displayed exaggerated incretin and endocrine pancreatic function with more than 50% increased levelsq of circulating insulin, GLP1 , and GIP and defective glucagon secretion, causing low plasma glucose levels and thus, increased risk of symptomatic reactive hypoglycemia following the glucose load.                                                 Furthermore, in rats, pharmacological blockade of these voltage gate at potassium channel 11.1 with [inaudible 00:02:43] had similar effects and inhibition of HERG in beta and L cells increased insulin and GLP1  secretion up to 50%. Finally, glucose ingestion aggravated cardiac repolarization disturbances in patients with long QT syndrome II with a 122% greater increase in QT interval in these patients compared to controls. The take home message is that clinicians should be more aware of the risk of hypoglycemia with glucose ingestion in patients with long QT II syndrome and also recognize that this reactive hypoglycemia can further increase the risk of malignant arrhythmia in these patients.                                                 The next paper is the first study to describe the risk of myocardial infarction after discontinuation of thienopyridine therapy in the DAPT study, or dual antiplatelet therapy study. As a reminder, in this trial, after PCI and 12 months of clopidogrel or prasugrel plus aspirin, eligible patients remained on aspirin and were randomized to continue thienopyridine  versus placebo for 18 months. At 30 months, patients stopped the study drug and were observed for three months. In the current study by first author Doctor Schmidt, corresponding author Doctor Mauri, and colleagues from Brigham and Women's Hospital in Boston, Massachusetts. The authors looked at cumulative incidents of myocardial infarction assessed over three months after randomization and three months after study drug discontinuation. They found that discontinuing thienopyridine after either 12 or 30 months was associated with an early increase in myocardial infarction risk, mainly unrelated though to stent thrombosis. The magnitude of risk was highest in the early time frame and lower in patients not treated with the [inaudible 00:04:47] eluting stents.                                                 The authors further compared pateints with DAPT scores above or below 2, and showed that both groups had lower rates of myocardial infarction with continued thienopyridine . Thus, while higher DAPT scores identify patients with a greater absolute ischemic benefit relative to bleeding with continued thienopyridine therapy, discontinuation at 12 months increases the myocardial infarction hazard regardless of DAPT score group.                                                 The next paper describes the impact of depression treatment on one year mortality following acute myocardial infarction. Doctor [inaudible 00:05:28] and colleagues from the University of Missouri School of Medicine in Kansas City looked at the TRIUMPH study, which is an observational multicenter cohort study that enrolled more than 4000 patients with acute myocardial infarction between 2005 and 2008 from 24 US hospitals.                                                 Patients were administered the patient health questionnaire 9 during the index myocardial infarction admission and depression was defined by a score of 10 or above. This was categorized as treated if there was a documentation of a discharged diagnosis, medication prescribed for depression, or referral for counseling, and is untreated if none of these three criteria were documented. Overall, 18.7% of patients met criteria for depression and 30.4% were treated. Compared without depression, patients with treated depression had one year mortality rates that were not different. However, patients with untreated depression had a higher one year mortality when compared to patients without depression. In summary, this study really shows that the association between depression following myocardial infarction and increased mortality differs by depression treatment status at the time of the index myocardial infarction. Patients with untreated depression have a 70 to 90% higher risk of dying at one year after the myocardial infarction than patients without depression or patients with treated depression. These findings should therefore encourage further research to examine the impact of depression recognition and treatment at the time of an acute myocardial infarction.                                                 The final study provides insight into the paradox that folate deficiency is an independent risk factor for congenital heart disease, yet the maternal plasma folate level is paradoxically not a good diagnostic marker of this risk. In the current study by first author Doctor Wang, co corresponding authors Doctors Chow and Wang, from Fudan University, Shanghai, China. The authors examined six folate related polymorphisms in three independent case control groups comprising 1489 patients with congenital heart disease and 1745 healthy individuals from the Han Chinese population. They found that a specific fidgetin intronic 4 variant was associated with decreased circulating folate levels and increased protection against congenital heart disease. They further showed that increased fidgetin expression inhibited proteasomal degradation of reduced folate carrier 1 and dihydrofolate reductase, thus facilitating [inaudible 00:08:29] uptake and metabolism of folate. Their results therefore demonstrated that folate utilization, rather than the circulating folate levels, determined the preventive effects of folate against congenital heart disease. These findings provide new insights into the relationship of circulating folate levels with congenital heart disease and potentially other folate associated diseases.                                                 Well, that wraps it up for your summaries. Now, for our feature discussion.                                                 Today's feature paper really represents the first data we have that tells us what our cardiovascular health in middle age is doing to us in older age, in terms of both morbidity and longevity. To discuss this paper today, I'm so happy to have the first and corresponding author, Doctor Norrina Allen from Northwestern University in Chicago and Doctor Jarett Berry, associate editor from UT Southwestern. Welcome, both. Dr Norrina Allen:              Thank you very much. Dr Jarett Berry:                 Thanks, Carolyn. Dr Carolyn Lam:                Norrina, could I start with you? This represents the 40 year follow up of the Chicago Heart Association detection project and industry. Could you maybe start by telling us a little bit about the Chicago Heart Association study? Dr Norrina Allen:              The Chicago Heart Association study was a large study that recruited almost 40,000 individuals who were employed in Chicago. They did a baseline exam between 1967 and 1973. After that baseline exam, we followed those individuals for over 40 years using their Medicare records, so we've been able to monitor their healthcare utilization and the incidence of disease across their lifetime up through 2010. Dr Carolyn Lam:                Then you measured their cardiovascular health by specific measurements, right? Could you tell us how that was defined and then also how was morbidity burden defined? Dr Norrina Allen:              Of course. We really think the overall burden of cardiovascular health tells us something more than looking at individual risk factors, so we classified each of the CHA participants into one of four groups, and each of those groups was defined by the level of main cardiovascular risk factors, including blood pressure, BMI, diabetes, smoking, and cholesterol level. We identified people who had favorable levels of all of those risk factors, individuals who had one elevated but not clinically of those high risk factors, individuals who had one high level, or individuals who had two or more high levels. That was based on their baseline exam. Overall we found that about 6% of the CHA participants had favorable levels of all of the risk factors at baseline, 19% had one or more that was elevated, 40% had one high, and 35% had two or more high risk factors, and again this was at the baseline exam when they were young to middle aged.                                                 We then followed them, as I mentioned, using Medicare data and we identified the burden of whole morbidity based on the ICD9 codes in their Medicare record, and we identified the level of morbidity for each year of age, from entry into Medicare, [inaudible 00:11:54] all the way to their death. Dr Carolyn Lam:                And now, drum roll, your findings, they were pretty stunning. Dr Norrina Allen:              Yeah. As you mentioned when you introduced the study, this study is really the first to look at the whole of an individual's later life, meaning not just looking at the incidence of disease or longevity but taking those both into account. What we were particularly interested in was looking at the cumulative burden of morbidity in older age and the relative proportion of life that people live with cardiovascular or all cause morbidity. What we found was that individuals, who at baseline in young and middle age and favorable levels of all major cardiovascular risk factors, lived longer by almost four years but they also delayed the onset of all cause and cardiovascular morbidity by 4 and a half and almost 7 years respectively. What that means is that the proportion of their life that they live with morbidity was much shorter, they lived longer and healthier as compared to individuals who had one or two more high risk factors. Dr Carolyn Lam:                What an important public health message. Jarett, this concept of morbidity compression, tell us your thoughts. Dr Jarett Berry:                 This is a really important paper. We've known for a long time, of course, that low risk individuals live longer, but the question of whether or not low risk individuals lived better throughout their life has been incompletely understood. The problem is that because low risk individuals live longer, the question that many have asked is that when we live longer is there a so-called expansion of misery, which some have talked about? That we live longer, but we have the same burden of disease or is that extended time horizon with the extended life span ... is the burden of morbidity compressed into a shorter period of time? In order to do that you need a couple things. You need a very large study that's followed for a very long time. Importantly, not just follow them for a long period of time, but follow enough individuals all the way until death so you know not just the first part of the story but we know the end of the story.                                                 It really wasn't until [inaudible 00:15:18] paper, with not only the very large sample side but the very long term follow up until death, that we've been able to understand that actually low risk status in middle age does actually compress morbidity. This question of morbidity compression is not just an academic question but it actually has potential implications for cost savings and how we think about health care costs in our health care system. It'd be nice to hear [inaudible 00:15:18] thoughts about that as well, what else she found in regard to the Medicare costs. Dr Norrina Allen:              Right. As Jarett mentioned, not only from an individual perspective but at a societal level, what we're interested in is whether being in favorable cardiovascular health actually lowers healthcare costs at the same time as increasing an individual's health and longevity. What we found was that not only do the individuals in favorable health live longer and healthier, but they also have lower cumulative and annual healthcare costs, meaning that from a societal standpoint the compression of morbidity results in healthcare savings. We really think this is a strong method that provides support for earlier prevention efforts not only to improve an individual's quality of life but to reduce the healthcare costs associated with later life morbidity. Dr Carolyn Lam:                Indeed, what an important message to live longer and better and to save societal cost we need to get healthier cardiovascularly in middle age. Now, what really scares me though, is the statistic you told us a bit earlier. Only 6% of the individuals that you studied had a favorable level of all factors. What do you think this implies? What do you think needs to be done? Dr Norrina Allen:              Unfortunately, at this point, it's relatively rare in our population to reach middle age, 40 to 50 years of age, with favorable levels of all major cardiovascular risk factors. I think ... my research is really focused on trying to identify ways and times to intervene, to really help promote cardiovascular health early in life. I really think that we need to work hard to prevent the occurrence of these risk factors and the elevation of these risk factors much earlier in life. That means, even before the age of 40 and much earlier than that, we really need to be focusing on preserving cardiovascular health so that by the time individuals reach later life they can have a good quality of life and a longer, healthier life. Dr Jarett Berry:                 I think the issue of the fact that low risk status is rare is that's a challenge that we continue to wrestle with as a society and as investagators interested in this are and how to improve that. When you look at your data, Norrina, I guess one silver lining here is we do see that ... when you look across the strata of risk groups ... it wasn't just the low risk individuals that seemed to benefit. It seemed that there was a little bit of a dose response. The goal obviously is to promote low risk status, but if we could limit the prevalence of those at the highest risk and shift them down a little bit, that could also have potential implications. I'd be interested to hear your thoughts about that. Dr Norrina Allen:              I think that's very accurate. There really is kind of a dose response level, so that every risk factor that's favorable adds a benefit and the more we can do to reduce the high risk factors over time, the better the long term outcomes are likely to be. I do really think prevention doesn't only have to exist before the development of the risk factors, but also there's a benefit to reducing risk factors that may have already developed or are elevated, and to try and reduce their level. I would say that I think that's an interesting next step that we really want to look at and try and think about how best to intervene even at middle age and help improve outcomes much later in life. Dr Carolyn Lam:                Thank you, listeners, for joining us today. I'm sure you agree, it's such an important message. Share it with your friends and tune in next week.

Als Tinnitus wird ein durchgehender Pfeifton bezeichnet der oft als äußerst unangenehm empfunden wird.

The biller / coder shares responsibility with the clinician for the successful implementation of ICD-10. Discover different scenarios in which the review of the claim is driven by clinical documentation.

  Interview Starts 22:45   Jon Mica’s book is The Autistic Holocaust: The Reason Our Children Keep Getting Sick.   This book is well-researched and articulate, a must-read for anyone interested in the truth.    It’s every parent’s nightmare: their child diagnosed with an incurable neurological disorder. After years of developmental delays, worries, and suspicions – and vaccinations – Jon Mica’s son was diagnosed with Asperger syndrome, one of five disorders that comprise the “austistic spectrum disorder.” Big Government and Big Pharma have conspired to lie to us for decades. Vaccines aren’t all safe, and autism isn’t going away gracefully into the night.   We chat about ASD, data manipulation, rise in rates, herd immunity and how you can't sue the big corporations any more. Organizations like "Autism Speaks" and  "The Institute for Responsible Technology" are discussed.   http://www.ipgbook.com/mica--jon-e--contributor-297254.php    mailto:jon.e.mica@isp.com    In the Intro it's just Darren and Graham chatting about some upcoming events and sharing some listener stories and synchronicities. Thanks for the feedback and thanks for listening. Links to stuff chatted about in intro and episode:   Events coming to Calgary: https://ocseti.wordpress.com/ http://www.modernknowledge.ca/    Joseph Druet's email for Astrological readings by donation.... jdruetastrology@gmail.com    Links to Randal Carlson and Ed Nightingale:  http://sacredgeometryinternational.com/ http://www.thegizatemplate.com/  Links to Org's discussed in ep: http://vaccineliberationarmy.com/  https://www.autismspeaks.org/  http://www.trineday.com/    Grimerica’s Honey DoBeDoBeDo List: !! – Please Help support the show. Grimerica is fully and solely listener supported. We adhere to the Value for Value model.  0 ads, 0 sponsorships, 0 breaks, 0 portals and links to corporate websites… just many hours of unlimited content for free. Thanks for listening!! Check out all the other donation types, and get a Grimerica email addy:   http://www.grimerica.ca/support/   Vote for Napoleon’s Lost Bread Webcomic by Sharing and Hearting his Comics Everyday until the July 7th Listen live and join the chat: www.Mixlr.com/grimerica . Check out the updated schedule @: http://www.grimerica.ca/backstage/ Send us a postcard: http://www.grimerica.ca/contact/ Sign up for our newsletter http://www.grimerica.ca/news Leave a comment, ideas and guest/topic suggestions under any episode or blog http://www.grimerica.ca/ Leave a voicemail http://www.grimerica.ca/ SPAM Graham = and send him your synchronicities, feedback, strange experiences and psychedelic trip reports!! graham@grimerica.com Tweet Darren https://twitter.com/Grimerica Leave a review on iTunes and/or Stitcher https://itunes.apple.com/ca/podcast/the-grimerica-show/id653314424?mt=2# http://www.stitcher.com/podcast/the-grimerica-show  Thanks to Wayne Darnell for help with the website. http://www.darnelldigitalink.com/ Check oVaccine - Mewut the Paradigm Symposium 2015. We will be there again!! Year 4 http://paradigmsymposium.com/ http://www.live365.com/stations/roccijstucci MUSIC Grimerica Theme - Lock & Key Peanut Exposure - Autistic  Got Milk - Autistic Vaccine - Mew

The clinician has the highest responsibility with ICD-10 implementation, and is responsible for compliant, detailed documentation. This drives the selection of the right ICD-10 codes, which are reviewed by the biller / coder prior to claim submission.

Learn key insights about what the front desk can / should do and should avoid when it comes to ICD-10 implementation.

The 'clinical jigsaw puzzle' is a vivid picture of the clinical documentation that must support and reinforce the selection of the appropriate ICD-10 code.

Rehabilitation professionals like physical therapists and occupational therapists should understand the difference between medical and rehab diagnosis during the transition to ICD-10.

The sooner a clinician gains expertise with ICD-10 coding, the better. Preemptive documentation will allow clinicians to become familiar with the new coding and facilitate compliant, precise and detailed documentation.

The first few months of implementation will be a critical time for practices financially as they deal with inevitable errors that mistakenly deny claims and require multiple resubmissions, further slowing down the system and cash flow. In this podcast, protect yourself against the single biggest mistake in the transition.

Some consider ICD-10 to be the equivalent of the atomic bomb for private practice owners. On the contrary, it's an essential evolution and (for some), one of the biggest opportunities to improve quality of care and increase reimbursements.

The increased specificity and granularity associated with ICD-10 presents new financial opportunities for healthcare professionals.

Discover exactly what clinicians need to do to transition to ICD-10 with a simple approach towards compliant documentation.

In this short podcast, learn about the three concepts critical to your ICD-10 preparation.

ICD-10 codes will open new, unprecedented opportunities to communicate with patients in targeted, segmented ways like never before. Learn how ICD-10, when used correctly, can benefit your marketing efforts.

Relying on the CMS GEMs translations can cause problems with documentation, billing and coding due to a lack of specificity. Discover how to avoid dependence on GEMs.

It's crucial to assess the level of preparation of vendors (EMR, billing software, clearing house, billing staff) because a lack of preparation can lead to payment disruptions. Discover the right questions to ask as you prepare for ICD-10.this podcast.

The key differences between ICD-9 and ICD-10 codes explained.

There are a lot of different opinions on how best to prepare for ICD-10. In this episode, Nitin Chhoda will cut through all the clutter and help you understand the bottom line for ICD-10 transition.

The best approach to ICD-10 involves the identification of systems, software and people involved in the transition.

Discover how to create an inventory of, and prepare for changes in systems and software as you transition to ICD-10

Like it or not, ICD-10 will impact your relationships with payers and the way your claims are adjudicated. All clinical documentation is going to be subject to a higher level of scrutiny. Discover how to stay one step ahead of payers with this podcast.

In this episode, Nitin Chhoda PT, DPT provides a 10 minute overview of how to prepare for the upcoming ICD-10 transition.

Rick is a licensed physical therapist and owner of Gawenda Seminars and Consulting. He is an expert on Medicare billing, ICD9 and 10 coding, documentation compliance and practice management. He regularly speaks around the country on these topics and in this interview we focused on the medicare as it relates to physical therapy outpatient practice. […]